Brian Locke

#Eosinophilic Lung Disease

Simple Pulmonary Eosinphilia (Loeffler's Syndrome)

Illness Script

Who does it occur in?

Often have a history of atopic disease

How does it present?

Blood eosinophilia Mild dyspnea, cough Transient / migratory areas of consolidation or ground glass, usually with ill-defined margins. Often predominantly peripheral distribution. May have nodules

How is it diagnosed?

Acute Eosinophilic Pneumonia

###Illness Script:

Who does it occur in?

  • 20-40 years old
  • 2:1 male:female ratio.
  • Sometimes presents in people after they begin smoking (or vaping)
  • Can be caused by daptomycin, venlafaxine

How does it present?

  • Acute onset fevers, shortness of breath, hypoxemic respiratory failure

How is it diagnosed?

  • CXR abnormalities are non-specific, but similar to pulmonary edema (kerley b lines -> interstitial opacity -> air space consolidation, lower lobe predominance and bilateral)
  • CT shows bilateral consolidation, interlobular septal thickening, sometimes with associated pleural effusion
  • BAL with %eosinphils greather than 25%

How is it treated

  • responds within days to high dose corticosteroids, Rx'd for 2 weeks.
  • start after infectious pneumonia is excluded.
  • sometimes remits on its own
  • long term prognosis is excellent

Chronic Eosinophilic Pneumonia

Illness Script:

Who gets it?

How does it present?

  • Fever, cough, weight loss, malaise, dyspnea
  • Blood eosinophilia
  • Severe symptoms, last 3 months or more
  • CT with patchy, peripheral, homogenous air space consolidation (photographic negative of pulmonary edema). Sometimes may have crazy paving. Similar to organizing pneumonia, without the basilar predominance.
  • remains unchanged (unlike Loeffler's) unless steroids given.

How is it diagnosed

  • Lung biopsy, unless imaging findings are classic.

How is it treated

Rapid resolution with steroids

Hypereosinophilic syndrome

###Illness Script

Who does it occur in?

How does it present

  • Elevated blood eos for 6 months, multiorgan infiltration (morbidity from cardiac, cns involvement) -If pulm involvement: cough, wheeze, SOB
  • Hazy GGOs, pulmonary nodules 1cm or less in diameter in the peripheries on HRCT.

Eosinophilic Granulomatosis with Polygangiitis

aka Churg-Strauss; extravascular granulomas and necrotizing vasculitis with eosinophils infiltrating various organs.

Who gets it?

  • 40-50 years old
  • often hx of atopic disease.

How does it present?

  • Allergic/prodromal phase: rhinitis, sinusitis, asthma
  • Eosinophilic phase: Blood eosinophils over 10%, Lung (often resembles Loeffler's or chronic eosinophilic pneumonia) and GI involvement
  • Systemic Vasculitis phase: "Polyangiitis", heart, skin, MSK, CNS, kidney also involved - fever weight loss, malaise occur.

CXR w/ Transient pulmonary opacities, +/- nodules/masses, hemorrhage, edema, effusion.

HRCT with consolidation/GGOs (60%), bronchial wall thickening or bronchiectasis (35%), septal thickening (5%)

Cavitation is less common than with GPA

How do you make the diagnosis

  • send ANCAs (usually p-anca)
  • eosinophils extravascularly

How is it treated

  • Usually respond to steroids

Other eosinophilic lung conditions

  • Drug reactions
  • Parasite infections (Ascaris, Toxocara, Strongyloides), Tropical pulmonar eosinophilia
  • Fungal disease (ABPA)
  • Bronchocentric granulomatosis (necrotizing granulomas centered on bronchioles caused by hypersensitivity, upper lobe predominance)